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MEDicARE & MOSt inSuRAncE PlAnS AccEPtED Selecting a Medicare Advantage Plan Americans over age 65 are increasingly choosing the Medicare Advantage option. If you’re interested in joining them, here are some tips on how. By Hany Abdelaal, DO, President of VNSNY CHOICE Health Plans Over the past decade, the number of older Americans enrolled in a Medicare Advantage plan at any given time has soared from 5 million to over 16 million. In fact, Medicare Advantage plans, which are administered by private health insurers rather than by the federal government, now account for about one-third of all Medicare recipients. It’s not surprising that these plans, also known as MA or Medicare Part C plans, are growing in popularity. MA plans are required by law to give the same benefits as standard Medicare, and most also include added benefits above what standard Medicare provides. Many people pay nothing for their MA plans beyond their usual Medicare B premium. Even the more expensive Medicare Advantage plans carry only a modest additional premium—often under $100 per month. Every MA plan also includes a maximum annual out-of-pocket cost of $6,700 per recipient, providing a certainty that ordinary Medicare can’t match. With plentiful plans to choose from—the average Medicare recipient has access to 18 different MA plans—and flexibility to switch to another Medicare offering if desired (any Medicare recipient can change plans during Medicare’s open enrollment period of October 15 through December 7), it’s easy to see why more and more people are choosing the MA option. Determining if Medicare Advantage Is Right for You If you’re interested in exploring the Medicare Advantage option, the first step is to determine your eligibility. Virtually everyone over age 65 who qualifies for coverage under Medicare Parts A and B is eligible for Medicare Advantage, unless they have end-stage renal disease (meaning they require regular dialysis treatments). The next step is to check whether you live in an area that has Medicare Advantage plans available. As noted above, most Americans live in areas where multiple MA plans are available. With our VNSNY CHOICE Medicare plans, for example, you can enroll if you are a Medicare-eligible New Yorker living in New York City, Long Island, Westchester County, or the four upstate New York counties of Albany, Rensselaer, Saratoga and Schenectady. A third essential thing to know is whether your primary care doctor participates in any Medicare Advantage plans. Most primary care physicians are part of one or more MA networks—but if your doctor isn’t, you might have to change primary care physicians if you want to join MA (which most people are understandably reluctant to do). Which MA Plan is Best for You? If your answer to all three questions above is “yes,” then the next step is to carefully review the benefits and cost of the available Medicare Advantage plans in your home area. I strongly advise that you reach out to the individual companies offering these various MA plans to learn all the details about their offerings. One question to ask is whether the plan requires a referral from your primary care physician before you can see a specialist. You should also look into the plan’s out-of-network benefits: While all Medicare Advantage plans typically have a network of providers whose services are fully covered by the plan, some also provide a certain amount of coverage for out-of-network providers as well. Before you contact a specific plan, be sure to have a good idea of your annual income, since this will determine what subsidies you might be eligible for. Many individual insurers offer a variety of Medicare Advantage plans, with costs and benefits that may vary somewhat. Most plans have representatives available by phone or online to walk you through their offerings. At VNSNY CHOICE, our Medicare benefit representatives can be reached at our toll-free number, 888-387-4167, from 8 a.m. to 8 p.m., seven days a week, to answer your questions and arrange an in-person consultation with a representative who is fully versed in our plans. There is also an option to chat online with expert consultants on our website, vnsnychoice.org. With a range of enhanced benefits, a cap on annual out-of-pocket costs, and the care coordination and health planning services of an experienced insurance provider, the appeal of Medicare Advantage is clear. If you’re a Medicare recipient, I recommend taking a few minutes to explore the MA plans in your area. This is one instance where there’s a healthy advantage in knowing exactly what all your Medicare options are.
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